'Nerve bypass' helps paralysed man move arm

[manouli]

They don't say, they say above his injury so I say they use peripheral nerves right?


'Nerve bypass' helps paralysed man move arm

Published on Wednesday 22 August 2012 15:15


Revolutionary surgery has given a paralysed man the ability to move his arms and hands again, it has been widely reported. The surgery, which made global news, has shown that rewiring nerves may allow surgeons to restore basic arm and hand control after serious spinal cord injuries.

A 71-year-old patient had been left paralysed from the neck down after the base of his neck was injured in a traffic accident. In a world first, surgeons were able to successfully bypass the injury site by grafting arm nerves from below the injury to nerves originating above the site of his injury. The surgery was given 23 months after his accident, and after several more months of therapy and training the man can handle objects, feed himself and even do basic writing.

read....

http://www.lythamstannesexpress.co.u...-arm-1-4741070

[GRAMMY]

http://nerve.wustl.edu/news_C6-C7_spinal_injury.php

[jsilver]

http://nerve.wustl.edu/news_C6-C7_spinal_injury.php

Given David Muir's work I would suggest that a shot of chondroitinase at the site of nerve anastomosis would be very helpful to increase regeneration. I think this is way cool and something people have been trying to perfect for a very long time!

[kz]

Dr. silver ,
Hi , Can you contact the DR. who did this and see if you can work with him using your chondroitinase and his nerve grafts ? I think the combinations of your work and his is a fantastic and great combination approach (DREAM TEAM ) that might helps many of us ? What do you think ? Since he already did this with nerve graft , do you think you need FDA approval if you add chondroitinase to the equation , or you can do this without FDA approval ? I think this might be a great opportunity for you to help us get some feeling and / or functions back ;Please do whatever you can to take your work out of your lab and into the human trial , THANKS SO MUCH INDEED . Have good day Jerry.

[jsilver]

Dr. silver ,
Hi , Can you contact the DR. who did this and see if you can work with him using your chondroitinase and his nerve grafts ? I think the combinations of your work and his is a fantastic and great combination approach (DREAM TEAM ) that might helps many of us ? What do you think ? Since he already did this with nerve graft , do you think you need FDA approval if you add chondroitinase to the equation , or you can do this without FDA approval ? I think this might be a great opportunity for you to help us get some feeling and / or functions back ;Please do whatever you can to take your work out of your lab and into the human trial , THANKS SO MUCH INDEED . Have good day Jerry.

Good idea. I will write to Ida Fox and explain how chondroitinase could readily help her patients.

[GRAMMY]

Given David Muir's work I would suggest that a shot of chondroitinase at the site ofnerve anastomosis would be very helpful to increase regeneration. I think this is way cool and something people have been trying to perfect for a very long time!

http://nervesurgery.wustl.edu/ap/Ana...s/default.aspx

Nerve Anastomoses

OVERVIEW
Connections between nerves where fibers traditionally carried by one nerve travel within a different nerve and then return to join the original nerve more distally are termed nerve anastomoses.

These can explain unexpected findings in the setting of a specific known nerve injury.

DESCRIPTION

Martin-Gruber Anastomosis:

• Forearm level connection between the median and ulnar nerve.
• Can take many forms:

• One to two branches of fibers.
• Arise(s) from the median nerve, the median nerve branch to superficial flexor muscles, or the anterior interosseous nerve.
• Travels to the ulnar nerve in the forearm following an oblique or transverse course.

• Clinical relevance:

• In an ulnar nerve injury at a level proximal to the anastomosis, intrinsic ‘ulnar innervated’ hand function will remain preserved because those fibers were traveling with the median nerve and were therefore uninjured.
• In a median nerve injury at a level proximal to the anastomosis, all intrinsic muscle function will be absent because the median nerve fibers that innervate the thenar musculature and the fibers that go the remaining ‘ulnar innervated’ intrinsic muscles will all be denervated.

Riche-Cannieu:

• Hand level connections between the ulnar and median nerve.
• Can take many forms:

• Ulnar nerve can contribute motor fibers to the various thenar muscles through branches at the hand.
• Can innervate the flexor pollicis brevis, abductor pollicis brevis and/or opponens pollicis.

• Clinical relevance:

• Despite severe carpal tunnel syndrome, the motor musculature to the thenar eminence might be relatively spared.
• Despite median nerve injury proximal to the hand, the thenar musculature remains quite functional.

Nerve Injury Classification System


Nerve injuries are classified as follows:

• A first-degree injury, or neurapraxia, will recover within days after the injury, or it may take up to three months. The recovery will be complete with no lasting muscle or sensory problems.
• A second-degree injury, or axonotmesis, also will recover completely; however, the recovery will take much longer than with a first-degree injury.
• A third-degree injury also will recover slowly; in addition, only partial recovery will occur.
• A fourth-degree injury occurs when there is dense scar tissue within the nerve, completely blocking any recovery. Surgery is required for recovery.
• A fifth-degree injury involves complete separation of a nerve, such as a cut nerve. Surgery is required for recovery.
• A sixth-degree injury is a combination of other types of nerve injury. Recovery and treatment will vary depending on which types of nerve injury are present.

Diagrammatic Representation And Cross Section






Text and illustrations from Surgery of the Peripheral Nerve by Mackinnon and Dellon, reprinted with permission of Thieme Medical Publishers, Inc.

• a. Diagrammatic representation of the cross section of a normal peripheral nerve demonstrating the connective tissue and nerve tissue components.
• b. The cross section of the peripheral nerve demonstrates a mixed, or sixth degree, injury pattern. This fascicle (bundle of nerve fibers) at 11 o’clock is normal.

Moving counterclockwise, the adjacent fascicle demonstrates a first degree injury (neurapraxia) with segmental demyelination (loss of the myelin that covers many nerve fibers).
The next fascicle demonstrates a second degree injury (axonotmesis). This injury involves both the axon and the myelin. The endoneurial tissue (delicate connective tissue network that holds together the individual fibers of a nerve trunk) is not damaged.
The central two fascicles demonstrate a third degree injury, with injury to the axon, myelin and endoneurium. The perineurium (sheath of connective tissue that surrounds a bundle of nerve fibers) is intact and normal.
The fascicles demonstrate at 12 and 1 o’clock a fourth degree injury with marked scarring across the nerve, with only the epineurium being intact.
In a fifth degree injury pattern, the nerve is not in-continuity but is transected. The surgeon will separate the fourth and fifth degree injury patterns, which will require reconstruction from the normal fascicles and the fascicles demonstrating first, second and third degree injury patterns. These latter patterns of injury require, at most, neurolysis (destruction of nervous tissue).
Nerve Recovery and Regeneration

After nerve injury, the nerve will try to repair itself by sprouting regenerating nerve units. These regenerating units will then try to grow down the nerve to reinnervate (restore nervous function to) muscle or skin. If they make a correct connection — motor nerve to muscle or sensory nerve to skin — then recovery of muscle function and skin sensation will occur. However, if the regenerating nerve fibers do not make a correct connection, then no recovery will occur.
Peripheral Nerve Surgery

If surgery is necessary, there are several types of surgery that may be recommended.

For nerve regeneration, the regenerating nerve fibers need the guidance of the nerve for direction to the muscle or sensory unit. If the nerve has been cut, a nerve repair is used to sew the two ends of a nerve together. This usually is possible when the nerve has been cut sharply. However, in cases with more extensive damage, it may not be possible to sew the two ends of the nerve directly together once the damaged nerve has been trimmed away.

In these cases, a nerve graft is used. A small piece of donor nerve is used to bridge the gap between the two nerve ends, and the nerve will regenerate across this “bridge” to provide recovery. The donor nerve is taken from other areas of your body using small, noncritical sensory nerves.

In some cases in which sensory or muscle recovery is not anticipated for a very long time, a nerve transfer may be used. Nerve transfers use functioning nerves that are close to the target muscle or sensory area, and the nerves are transferred to the injured nerve.

A neurolysis (or nerve decompression) refers to the removal of scar or compressive structures (including fascia or tendonous edges of muscles) from the nerve and may be undertaken if external impediments (or tight "tunnels") are pinching the nerve, limiting the ability of the regenerating unit to pass through on its way to its target.

Other techniques to restore muscle function, tendon transfers and free functional muscle transplants, also are covered on our web site.

Patient information on nerve injury

[kz]

Dr. Silver ,
Thank you indeed .Please let us know.I sincerely hope that this can help to regain bowel and bladder control too. (my injury is T2 asia A complete" )

[jsilver]

Dr. Silver ,
Thank you indeed .Please let us know.I sincerely hope that this can help to regain bowel and bladder control too. (my injury is T2 asia A complete" )

Here is just one of many David Muir papers showing the effectiveness of ch'ase in peripheral nerve repair.

Exp Neurol. Author manuscript; available in PMC 2007 April 12.
Published in final edited form as:
Exp Neurol. 2007 January; 203(1): 185–195.
Published online 2006 September 12. doi: 10.1016/j.expneurol.2006.08.004
PMCID: PMC1851897
NIHMSID: NIHMS15752
Chondroitinase Applied to Peripheral Nerve Repair Averts Retrograde Axonal Regeneration

James B. Graham, Debbie Neubauer, Qing-Shan Xue, and David Muir
Author information ► Copyright and License information ►
The publisher's final edited version of this article is available at Exp Neurol
See other articles in PMC that cite the published article.
Go to:
Abstract
Antegrade, target-directed axonal regeneration is the explicit goal of nerve repair. However, aberrant and dysfunctional regrowth is commonly observed as well. At the site of surgical nerve coaptation axonal sprouts encounter fibrotic connective tissue rich in growth-inhibiting chondroitin sulfate proteoglycan that may contribute to misdirection of axonal regrowth. In the present study we tested the hypothesis that degradation of chondroitin sulfate proteoglycan by application of chondroitinase at the site of nerve repair can decrease aberrant axonal growth. Adult rats received bilateral sciatic nerve transection and end-to-end repair. One nerve was injected with chondroitinase ABC and the contralateral nerve treated with vehicle alone. After 28 weeks, retrograde axonal regeneration was assessed proximal to the repair by scoring neurofilament-immunopositive axons within the nerve (intrafascicular) and outside the nerve proper (extrafascicular). Intrafascicular retrograde axonal growth was equivalent in both control and chondroitinase treatment conditions. In contrast, chondroitinase treatment caused a pronounced (93%) reduction in extrafascicular retrograde axonal growth. The decrease in axon egress from the nerve was coincident with an increase in antegrade regeneration and improved recovery of motor function. Based on these findings we conclude that chondroitinase applied at the site of nerve transection repair averts dysfunctional extrafascicular retrograde axonal growth.

[quadfather]

Want to guess how this is going to turn out...

Anybody else frustrated that smart, altruistic and willing surgeons and scientists, with no profit-motive, are not able to try seemingly straight-forward and research supported treatments?

[rjames]

This sounds like a similar approach to what Dr. Brown is doing at UCSD in San Diego. I am going to accompany a quadriplegic friend of mine next week when he meets with Dr. Brown about getting the procedure done.

[nrf]

This sounds like a similar approach to what Dr. Brown is doing at UCSD in San Diego. I am going to accompany a quadriplegic friend of mine next week when he meets with Dr. Brown about getting the procedure done.

Please let us know your thoughts afterwards. We are setting up an appointment for our son in January.

[GRAMMY]

Both Dr. Justin Brown and Dr. Jerry Silver will be presenting in Irvine CA on November 1 - 2nd for anyone interested. http://www.unite2fightparalysis.org/2012_agenda

[Isildur]

I saw the video, but I didn´t see any real hand/finger movement, only usual C7 quad wrist movement. Im missing something?

[beuty]

Why the difference in hand recovery between this tow clips is so big?

http://www.youtube.com/watch?v=yvawDbkixz8

[KIM]

I saw the video, but I didn´t see any real hand/finger movement, only usual C7 quad wrist movement. Im missing something?

Says arm, no hand finger.